蕭裕泉醫師眼科筆記

International techniques and technology Expanding indications for the use of anti-VEGF drugs -------------------------------------------------------------------------------- by Maxine Lipner Senior EyeWorld Contributing Editor Anti-VEGF agents provide a good option for conditions such as retinal vein occlusion, which were otherwise very limited Patients with diabetic retinopathy are among the expanding group that can benefit from anti-VEGF agents Source (all): Amar Agarwal, M.D. Looking beyond the obvious Growing applications Practitioners here and abroad have adopted these neovascular wonder drugs for a host of ocular problems well beyond FDA-approved macular degeneration. "Many people use them for choroidal neovascularization of any etiology, pathological myopia, ocular histoplasmosis, idiopathic choroidal rupture, any inflammatory disease, and android streaks," said Susan B. Bressler, M.D., professor of ophthalmology, Wilme...

The non-surgical option for vitreoretinal diseases -------------------------------------------------------------------------------- by Faith A. Hayden EyeWorld Staff Writer A graphic of the ocriplasmin molecule Source: ThromboGenics  A non-surgical treatment for symptomatic vitreomacular adhesion (VMA) including macular hole, vitreomacular traction syndrome (VMT), and epiretinal membrane (ERM) is now in the hands of the FDA. In April, ThromboGenics (Iselin, N.J.) submitted ocriplasmin for priority review by the agency, which could reach a decision on the drug by the end of the year. ThromboGenics is also pursuing European commercialization. Ocriplasmin could be available in Europe as early as October. "The product has been in development for eye diseases for about 5 years," said Ram Palanki, head of marketing, ThromboGenics. "We went through Phase I, II, and got our Phase III data in August of 2010. That's when we decided to go for the submis...

糖尿病視網膜病變治療的新趨勢 署立基隆醫院 ＊台大醫院 眼科部 游建章 楊長豪＊ 前言         由於社會型態及生活習慣的改變與環境的變遷，糖尿病的盛行率逐年上升，糖尿病是開發中及已開發國家失明的主要原因之一。估計目前全世界有超過3億人口患有糖尿病，尤其在亞洲新興國家，其中有1/3在印度及中國。而根據世界衛生組織（WHO）統計糖尿病患比沒有糖尿病的人高出10-20倍的失明機會。在台灣糖尿病視網膜病變也是台灣中老年失明最重要的原因。而不論是第一型或第二型糖尿病的患者，都會受到糖尿病視網膜病變的影響。         在Wi s cons in糖尿病視網膜病變流行病學研究(wisconsin epidemiological study of diabetic retinopathy, WESDR)發現糖尿病視網膜病變的盛行率在第一型糖尿病病患確診三年、五年、十年、十五年後，分別為8%、25%、60%及80%，發病二十年後幾乎全部患者呈現不同程度的視網膜病變。 反觀第二型糖尿病患者於診斷成立之初，就有21%患者有視網膜病變，而且在發病二十年後則有60%患者發生視網膜病變。 糖尿病對眼睛的影響甚多，主要是視網膜病變，尤其以增殖性視網膜病變及黃斑水腫最會危及視力。糖尿病黃斑水腫造成視力損傷約有2.75％，對生活機能及品質的影響巨大。         糖尿病視網膜病目前一般接受的致病機轉如下：糖尿病病人在高血糖的狀況下，會經由polyol (聚醇)及hexosamine(己糖胺)途徑會合成diacylglycerol-prtein kinase C (DAG-PKC)、自由基、及 醣化產物 (advanced glycosylation endproducts, AGEs )。而這些正是糖尿病網膜病變的主要成因1,2。另外，有許多研究顯示，發炎反應在糖尿病網膜病變致病機轉上扮演重要的角色3。而這些途徑被活化後會導致視網膜神經層及視網膜微血管病變。這些影響包括增加細胞凋亡、神經膠細胞活化，及glutamate代...

Retinoic acid may be key to dry, wet AMD treatments by Michelle Dalton EyeWorld Contributing Editor ------------------------------------------------------------ Patients receiving the 300 mg dose of fenretinide showed significant reduction of retinol binding protein and reduced lesion growth from baseline when compared to placebo Source: ReVision Therapeutics A synthetic retinoid derivative has been able to slow lesion growth and preserve visual acuity in patients with geographic atrophy (GA). Further, when the patients were able to achieve sustained reductions in retinol binding protein (RBP) levels of 60-75% (indicating a positive response to fenretinide), these same patients had a lesion growth rate of about half what those receiving placebo experienced when the RBP reduction threshold was met. "Fenretinide may improve clinical outcomes for patients with both dry and wet forms of age-related macular degeneration," said Jason Slakter, M.D., clinical professor of ophth...

One or more serving per week of fish and shellfish high in omega-3 fatty acids had a reduced risk of advanced AMD as compared to those who consumed fish or shellfish less frequently.